Suboptimal Bowel Preparation Significantly Impairs Colonoscopic Detection of Non-polypoid Colorectal Neoplasms

Abstract

Suboptimal (fair or poor) bowel preparation significantly impairs colonoscopic detection of NP-CRNs. Given that the prevalence of NP-CRNs is substantial in our average-risk screening cohort, ongoing efforts to improve the preparation quality are practically valuable in increasing the detection of NP-CRNs, thereby improving the efficacy of screening colonoscopies.

Water Exchange Versus Split-Dose Bowel Preparation and the ADR: Is WE There Yet?

“…The adverse effects of bowel preparation on the ADR have encouraged considerable research into improvement in bowel preparation quality. Inadequate bowel preparation decreased, whereas high-quality cleansing increased the ADR, particularly for flat lesions (e.g., sessile serrated polyps) [2]. Screening colonoscopy is not a cost-effective strategy when compared with fecal immunochemical test if the inadequate bowel preparation rate is > 13% [3].…”

“…They speculated that the time savings may have been due to a reduced need to suction and wash the bowel. In an earlier retrospective report [2], patients received split-dose regimen of 4L polyethylene glycol (PEG-3350) solution for morning colonoscopies or a same-day regimen of 4L PEG-3350 for afternoon examinations. The report [2] discussed intra-procedural bowel cleansing as a solution for patients with inadequate bowel preparation.…”

“…In an earlier retrospective report [2], patients received split-dose regimen of 4L polyethylene glycol (PEG-3350) solution for morning colonoscopies or a same-day regimen of 4L PEG-3350 for afternoon examinations. The report [2] discussed intra-procedural bowel cleansing as a solution for patients with inadequate bowel preparation. The practice could reduce the need for early repeat colonoscopy, thereby reducing costs, and patient and endoscopist time and inconvenience while potentially improving outcomes [7].…”

Intraprocedural Cleansing for Screening Colonoscopy: Avoiding Brownouts

“…Modifiable factors with an impact on adenoma detection rate (ADR) include increasing the length of time used for withdrawal inspection, looking behind folds, and retroflex examination for the detection of NP-CRNs. There is current emphasis regarding improving bowel cleanliness which improves recognition and facilitates complete resection of NP-CRNs, sessile serrated polyps, and advanced adenomas [4].In this issue of the Digestive Diseases and Sciences, Oh et al [5] evaluated the impact of the quality of bowel cleansing on detection of NP-CRNs. In a retrospective analysis of screening colonoscopy performed by seven board-certified attending gastroenterologists at one academic teaching hospital, patients underwent recommended split-dose bowel preparation, with endoscopic removal of fecal debris and retained fluid accomplished by forceful irrigation and suction, prior to rating bowel preparation quality.…”

“…Efforts to improve the preparation quality increased the detection rate of NPCRNs, improving the efficacy of screening colonoscopies. Interestingly, the split-dose bowel preparation, formerly lauded for its efficacy on the basis of clinical trial data, was less perfect in real-life clinical settings, necessitating intraprocedural cleansing.In the study by Oh et al [5], the primary outcome was a comparison of the adenoma detection rate (ADR) for nonpolypoid lesions according to quality of bowel preparation. The overall ADR of non-polypoid pathology, 12.3 % (747/ 6097) of all colonoscopies, significantly differed between participating endoscopists.…”